Is there a role for discography? One of the issues that comes up quite frequently is whether patients can be selected for cervical fusion or for artificial disc based on discography.
Discography is a procedure where a needle is inserted into the disc space and two things are evaluated.
1. Does the injection recreate the patient’s normal neck pain?
2. After the injection, with just using a dye, a CAT scan is done to see where the dye went giving an indication of whether the fibers in the disc material itself are torn.
The reasoning here is that when liquid dye under a little bit of pressure is injected into a the disc that is causing pain, it will recreate that pain. Likewise, if injected into a disc that is not intrinsically painful, the injection will not cause pain.
This topic is very controversial. So to answer the question, Dr. Randhawa and Dr. Raab reviewed the subject matter in the July-August issue of SpineLine, a journal where I had been until recently one of the editors. It is published by the North American Spine Society.
The conclusion is really quite interesting and states that the available evidence supporting cervical discography remains controversial and limited.
On the basis of their review of the available evidence, they conclude that routine use of cervical discography as a tool for recommending anterior cervical discectomy and fusion or an artificial disc in those patients with chronic neck pain may not be warranted particularly in those patients with normal imaging and no neurological deficit.
So, if your physician is recommending that you have a cervical discogram, I suggest that you discuss this SpineLine article and the results I discussed with your surgeon.
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Jack Stern, M.D., Ph.D., F.A.C.S.
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